Charles Richard Seaberg Jr., LCDC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

3251 Issued in TX

Practice address

111 NW 24TH St
Fort Worth, TX 76164-8544

Phone

(817) 626-6401

NPI assigned

Mar 1, 2013

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• PSP Professional Services, Inc.

  • Professional Counselor
  • Fort Worth, TX
  • NPI 1922298322
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1362096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362096000000",
    "number": "1710227624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5704 HAVANA DR",
            "city": "NORTH RICHLAND HILLS",
            "state": "TX",
            "postal_code": "761806120",
            "telephone_number": "817-929-2936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 NW 24TH ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761648544",
            "telephone_number": "817-626-6401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEABERG",
        "first_name": "CHARLES",
        "middle_name": "RICHARD",
        "name_suffix": "Jr.",
        "credential": "LCDC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-03-01",
        "last_updated": "2013-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "TX",
            "license": "3251",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William B. Scroggie, M.D.
• Thomas Andrew Scully, DO
• Sculpted Body Medspa LLC
• SD Meadowbrook PLLC
• SDM ASC LLC
• Candace Seagraves, O.D.
• Andrea Christine Seal, LCDC-I
• Alexandra Danielle Seale
• Ashlie Nichole Seale, PMHNP-BC
• Julie Marie Seale, NNP

• Addiction (Substance Use Disorder) Counselor in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Addiction (Substance Use Disorder) Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.